Rubén Nieto

The fear-avoidance model in whiplash injuries

The aim of this work was to study whether fear of movement, and pain catastrophizing predict pain related‐disability and depression in sub‐acute whiplash patients. Moreover, we wanted to test if fear of movement is a mediator in the relation between catastrophizing and pain‐related disability/depression as has been suggested by the fear‐avoidance model [Vlaeyen JWS, Kole‐Snijders AMJ, Boeren RGB, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain 1995;62:363–72]. The convenience sample used was of 147 sub‐acute whiplash patients (pain duration less than 3 months). Two stepwise regression analyses were performed using fear of movement and catastrophizing as the independent variables, and disability and depression as the dependent variables. After controlling for descriptive variables and pain characteristics, catastrophizing and fear of movement were found to be predictors of disability and depression. Pain intensity was a predictor of disability but not of depression. The mediation effect of fear of movement in the relationships between catastrophizing and disability, and between catastrophizing and depression was also supported. The results of this study are in accordance with the fear‐avoidance model, and support a biopsychosocial perspective for whiplash disorders.

The Catalan version of the Pain Catastrophizing Scale: a useful instrument to assess catastrophic thinking in whiplash patients.

UNLABELLED The main aims of this work were to test the psychometric properties of the Catalan version of the Pain Catastrophizing Scale (PCS) and to assess the usefulness of the scale when used with whiplash patients. This article reports results from 2 complementary studies. In the first one, the PCS was administered to 280 students and 146 chronic pain patients to examine the psychometric properties of a new Catalan version of the instrument. A confirmatory factor analysis supported a second-order structure, in which 3 second-order factors (ie, rumination, helplessness, and magnification) load in a higher-order factor (ie, catastrophizing). The reliability of the Catalan version was supported by an acceptable internal consistency and test-retest values. Validity was supported by the correlations found among the PCS and pain intensity, pain interference, and depression. The objective of the second study was to evaluate the PCS when used with whiplash patients. In this second study, 141 patients with whiplash disorders participated. In general, the psychometric properties of the PCS were found appropriate, with factor analysis supporting the structure described in patients with chronic pain. Our data suggest that the PCS is a good instrument to assess catastrophic thinking in whiplash patients. PERSPECTIVE The usefulness of the PCS in whiplash disorders has been explored in this study. Results of our work show that the PCS can be a very useful tool to assess catastrophic thinking about pain in whiplash patients.

Disability in subacute whiplash patients: usefulness of the neck disability index.

Study Design. Cross-sectional study. Objective. To analyze the psychometric properties of the neck disability index (NDI), with a special emphasis in its factor structure, and its usefulness, in a sample of patients suffering from a subacute whiplash problem. Summary of Background Data. A valid and reliable instrument to assess pain-related disability would be of great help to clinicians and researchers interested in whiplash associated disorders. First, to better understand the impact of whiplash on the patient’s life, and his or her progress over time. Second, to formulate comprehensive treatment plans, and evaluate the results from therapeutic actions. Finally, to follow-up patients’ changes and improvement. The NDI could be an appropriate instrument for these purposes. Methods. A convenience sample of 150 subacute whiplash patients participated. They were requested to complete the Catalan version of the NDI, and report about their pain intensity, pain interference and depression. Results. An exploratory factor analysis showed that the NDI can be viewed as a 2-factor instrument. The items and the instrument’s total score were normally distributed. Internal consistency was also appropriate both for the total score (Cronbach’s &agr;: 0.87) and the 2 subscales (0.7 for the pain and interference with cognitive functioning scale, and 0.83 for the physical functioning scale). Total NDI and subscales scores significantly correlated with pain intensity, pain interference, and depression. Conclusion. The NDI showed excellent psychometric properties in a sample of subacute whiplash patients. Additional research is needed to replicate the NDIs factor structure.

Predictive factors of chronic pain and disability in whiplash: a Delphi poll.

The purpose of this study was to establish consensus on what factors might predict chronic pain and disability in whiplash injuries following motor vehicle collisions.

Changes in pain-related beliefs, coping, and catastrophizing predict changes in pain intensity, pain interference, and psychological functioning in individuals with Myotonic Muscular Dystrophy and Facioscapulohumeral Dystrophy

ObjectivesThe primary aim of this study was to test hypothesized associations between changes in psychological variables (ie, pain beliefs, catastrophizing, and coping strategies) and changes in pain intensity and related adjustment (ie, pain interference and psychological functioning) in individuals with myotonic muscular dystrophy (MMD) and facioscapulohumeral muscular dystrophy (FSHD). MethodsA sample of 107 adults with a diagnosis of MMD or FSHD, reporting pain in the past 3 months, completed assessments at 2 time points, separated by approximately 24 months. ResultsResults showed that changes in pain-related psychological variables were significantly associated with changes in psychological functioning, pain intensity, and pain interference. Specifically, increases in the belief that emotion influences pain, and catastrophizing were associated with decreases in psychological functioning. Increases in the coping strategies of asking for assistance and resting, and the increases of catastrophizing were associated with increases in pain intensity. Finally, increases in pain intensity and asking for assistance were associated with increases in pain interference. DiscussionThe results support the use of the biopsychosocial model of pain for understanding pain and its impact in individuals with MMD or FSHD. These findings may inform the design and implementation of psychosocial pain treatments for people with muscular dystrophy and chronic pain.

The Inventory of Parent/Caregiver Responses to the Children’s Pain Experience (IRPEDNA): Development and preliminary validation

&NA; This paper describes the development and preliminary validation of a self‐administered instrument designed to measure parents/caregivers’ responses to children’s pain episodes. For empirical validation purposes, a 60‐item inventory was answered by 401 adults whose children’s ages ranged from 6 to 16 years (mean = 10.44, and SD = 2.25 years). Factor structure and item analyses led to a 37 item inventory with three interrelated scales, namely: solicitousness (n = 15 items), discouragement (n = 10 items), and promotion of well‐behaviors and coping (n = 12 items). The three scales had good internal consistency, with coefficient alphas of 0.87, 0.83 and 0.87, respectively; they also showed good criterion‐related validity.

Are coping and catastrophising independently related to disability and depression in patients with whiplash associated disorders

Purpose. The aim is to study how pain coping strategies and catastrophising are related to disability and depression in patients with whiplash-associated disorders (WAD). Specifically, we wanted to test if they are independent predictive variables, after controlling for pain severity, sociodemographic and crash-related variables. Methods. A convenience sample of 147 patients with WAD of less than 3 months of duration was recruited. They were requested to complete the Pain Catastrophising Scale, the two-item version of the Chronic Pain Coping Inventory and to report sociodemographic and crash-related information, pain intensity, disability and depression. Results. Although several pain coping strategies were related with disability in univariate analyses, only asking for assistance was a marginally significant predictive variable in a multiple regression analysis after controlling for catastrophising. Catastrophising was a significant predictive variable after controlling for pain coping strategies. With depression as the outcome, resting and task persistence were the only pain coping strategies which were related in univariate analyses. However, none of them were predictive variables after controlling for catastrophising. Again, catastrophising was a significant predictive variable after controlling for pain coping strategies. Conclusions. Our results show that catastrophising about pain is more important than pain coping strategies in patients with WAD of a short duration. These results can contribute to the conceptual distinction between pain coping strategies and catastrophising.

The factor structure and factorial invariance of the Pain‐Coping Questionnaire across age: Evidence from community‐based samples of children and adults

The Pain‐Coping Questionnaire was developed for children to assess pain‐coping strategies. It was originally suggested as a second‐order factor measure: eight first‐order factors and three higher‐order factors. The main objective of this study was to investigate the psychometric properties of the PCQ when used with children and adults. Two samples of 702 children and 590 adults completed the measure. Confirmatory factor analytic procedures were used to examine the factor structure, and invariance across samples. The results provided good support for a second‐order structural model of seven subscales for children, for a first‐order structural model of seven subscales for adults, and for between‐group invariance first‐order structural model. These findings suggest that data obtained on the seven first‐order factors from children are directly comparable to scores from adults. The internal consistency, criterion validity and convergent validity were also confirmed in both children and adult samples. This work also reports some preliminary findings related to sex and age differences on the use of pain‐coping styles.

Differential effects of two virtual reality interventions: distraction versus pain control

There is evidence that virtual reality (VR) pain distraction is effective at improving pain-related outcomes. However, more research is needed to investigate VR environments with other pain-related goals. The main aim of this study was to compare the differential effects of two VR environments on a set of pain-related and cognitive variables during a cold pressor experiment. One of these environments aimed to distract attention away from pain (VRD), whereas the other was designed to enhance pain control (VRC). Participants were 77 psychology students, who were randomly assigned to one of the following three conditions during the cold pressor experiment: (a) VRD, (b) VRC, or (c) Non-VR (control condition). Data were collected regarding both pain-related variables (intensity, tolerance, threshold, time perception, and pain sensitivity range) and cognitive variables (self-efficacy and catastrophizing). Results showed that in comparison with the control condition, the VRC intervention significantly increased pain tolerance, the pain sensitivity range, and the degree of time underestimation. It also increased self-efficacy in tolerating pain and led to a reduction in reported helplessness. The VRD intervention significantly increased the pain threshold and pain tolerance in comparison with the control condition, but it did not affect any of the cognitive variables. Overall, the intervention designed to enhance control seems to have a greater effect on the cognitive variables assessed. Although these results need to be replicated in further studies, the findings suggest that the VRC intervention has considerable potential in terms of increasing self-efficacy and modifying the negative thoughts that commonly accompany pain problems.

Pain-related fear of movement and catastrophizing in whiplash-associated disorders

OBJECTIVE The main aim of this study was to test whether pain-related fear of movement and catastrophizing were predictors of pain intensity and disability 6 months after a whiplash injury. The mediator role of fear of movement was also explored. A sample of 147 whiplash patients with neck pain for less than 3 months participated in the first assessment, and 123 of them were interviewed again at a 6-month follow-up. Multiple regression analyses were performed. RESULTS Fear of movement, initial pain intensity and initial disability were independent predictors of disability at the 6-month follow-up. Initial pain intensity and initial pain duration were significant predictors of pain intensity at 6 months. Fear of movement was found not to be a mediator in either of the 2 outcomes at the 6-month follow-up. CONCLUSIONS These findings suggest that interventions designed to reduce the impact of injury severity and pain-related fear of movement after a motor vehicle accident may be relevant for preventing long-lasting symptoms.